Introduction
This case report seeks to highlight a rather uncommon yet important complication of caesarean section; Ogilvie’s Syndrome (OS). This syndrome describes the phenomenon of an acute colonic pseudo-obstruction (ACPO), often without an obvious mechanical cause. The obstruction can then lead on to bowel perforation or ischemia.
Case Report
We present a case of a young, healthy primigravida who developed OS on Day 6 post caesarean section (CS), complicated by a perforated caecum and fecal peritonitis. We will summarize the sequence of events, management and outcome of the patient in this report.
Conclusion
We hope that this report will pique the interest of obstetricians as well as the midwifery staff in terms of prompt
…show more content…
Clinically, it would be rather challenging to differentiate between OS and paralytic ileus in the initial stage.
CASE REPORT
A 19 years old G1P0 presented for Induction of Labour (IOL) as she was term at 41 weeks. Antenatal care had been uneventful, and she was categorized as a low-risk pregnancy.She was induced with 1mg of ProstinD Gel followed by artificial rupture of membrane (ARM) the subsequent day which showed the presence of light meconium stained liquor. Her labour was augmented with SyntocinonD and routine labour monitoring was commenced with no abnormal recordings throughout labour. Following 12 hours of active labour with good progress initially, it then slowed down and arrested at 8cm. On examination cervix was found to be 8cm dilated and baby was in direct occiput-posterior position. Subsequently, A Category 2 emergency Caesarean Section for failure to progress was called.
Caesarean section went smoothly, and abdomen entered via Joel Cohen technique, peritoneal cavity and pelvic organs appeared normal. No electrocoagulation instruments were used
She is without complaints. She has not noted any increase in preterm labor. No signs/symptoms or change in pelvic pressure. She is compliant with bedrest and has help taking care of her son. She is otherwise aware that she should discontinue Motrin next week and is aware of the signs/symptoms that we are monitoring. The placental cord insertion does appear marginal as noted on prior ultrasound and we are following monthly growth. She is aware that after surveillance of cervical length which will the last one we would anticipate would be next week at 32 weeks and after that we would still recommend monthly evaluation of fetal growth. Preterm labor precautions were reviewed. She is scheduled to return in one
Consequently, cervical damage is another leading cause of long term complications following abortion. Normally the cervix is rigid and tightly closed. In order to perform an abortion, the cervix must be stretched open with a great deal of force. During this forced dilation there is almost always caused microscopic tearing of the cervix muscles and occasionally severe ripping of the uterine wall, as well. About 10% suffer immediate complications; one-fifth are life-threatening: • hemorrhage • infection • ripped or perforated uterus • cervical injury • embolism • anesthesia complications • convulsions • chronic abdominal pain • gastro-intestinal disturbances • endotoxin shock • second-degree burns • Rh
During the small bowel series, the radiologist was not able to determine the exact area of obstruction. The study was terminated after two hours and the patient was returned to her room. Following the small bowel series, the patient complained of abdominal pain and cramping. The patient’s tube was leaking bowel from the side of the tube and onto her abdomen. It was also noted that her parenteral nutrition was not adequate (LWR radiology, 2015).
On ultrasound there is a live fetus in breech presentation. Fetal biometry is consistent with menstrual dates. A detailed anatomic survey was unremarkable but slightly suboptimal
On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. A detailed anatomic survey was fairly unremarkable although slightly suboptimal due to late gestational age. There were no gross abnormalities seen. The placenta is anterior. Amniotic fluid was 8.3 cm. Umbilical artery Doppler was within normal limits.
This particular case study involves a 29 year old obstetric patient who presented to the labor and delivery unit at 33 weeks gestation with complaints of abdominal pain for the past three days that had become more severe and absence of fetal movement noted since the previous evening. Her obstetric history revealed she has one living child and has had one previous miscarriage at ten weeks
In depth discussion of planned and emergency C/S deliveries were also discussed. Planned C/S births were defined as “breech presentation, multiple pregnancy, preterm birth, small for gestational age, placenta praevia, morbidly adherent placenta, cephalopelvic disproportion in labor, mother-to-child transmission of maternal infection, Hepatitis B and C viruses, Herpes, and maternal request for C/S birth was outlined” (National Guideline Clearinghouse, 2011). An in-depth outline of anesthesia and surgical techniques followed. It seems that this source addressed nearly every type of C/S birth technique, including “method of placental removal, exteriorization of the uterus, closure of the uterus, peritoneum, abdominal wall, and subcutaneous tissue, use of superficial wound drains, closure of skin, and even timing of antibiotic administration and thromboprophylaxis for C/S births. Care of the woman after C/S surgery, routine monitoring, pain management, eating and drinking after surgery, and removing the urinary catheter after C/S surgeries was also discussed(National Guideline Clearinghouse, 2011)”. There is even a benefits/harms section that looks at potential risks and successes of C/S deliveries. The National Guidelines Clearinghouse
“Sefa’s had what we call a grade two placental abruption, which means the placenta has become slightly detached from the uterine wall. Sefa and the baby are fine for the moment, but since the baby’s already full-term, I don’t want to take any chances. Sefa’s agreed to a C-section, which I feel is the best and safest course of action. But it needs to happen immediately.”
Many woman give up in labor and beg the doctor to perform a cesarean section or many times the doctor does not want to wait for the laboring patient to progress on their terms and will call for a cesarean section. A cesarean section is a major abdominal surgery. Many woman are not educated in the short and long term effects of having one to be able to stay as far away from them. Maternal complications can be both physical and emotional due to the fact that the woman will not be able to care for her infant exclusively on her own during the recovery period. The first and most common complication with a cesarean section is surgical site infections. This could be caused by many things. It could be a cause of not cleaning the skin properly, a break in sterile technique, or personal hygiene of the wound during the recovery period. It can also be caused by the way the incision is closed. “ The use of staples for skin closure was associated with a marginally statistically significant increase in surgical site infections” (Corcoran 2013, pg. 1262). Infections can also be seen as urinary tract infections, endometritis, and pneumonia. Another complication that can occur from a cesarean section is a thrombus which can lead to pulmonary embolism. When a person has a cesarean section, they are bed bond more than a vaginal delivery. This causes the blood to not circulate in their legs
A commonly known procedure when it comes to hospital births are epidurals. An epidural is an injection of a drug between the “epidural space” which causes
The pain he developed in the right upper abdomen on 26 June 2010 may have been due to an hepatic subcapsular haematoma as the CT scan demonstrated fluid surrounding the liver and not elsewhere in the abdomen (appended images: page 2).
Fetal biometry is consistent with menstrual dates. A detailed anatomic survey was unremarkable. There were no structural abnormalities noted within the capabilities of our ultrasound equipment. There were no common markers of aneuploidy seen. The placenta is anterior, but clear of the LUS. Transabdominal cervical length was
The onset of her labor was on a Saturday morning. She thought she had had too many tacos, but then she lost her mucus plug. Labor was slow because her cervix would not dilate. She went to the hospital more than once, but the maternity ward would not admit her because her cervix was stuck at two centimeters. The obstetrics staff advised her to walk around which she did. She took multiple hot baths to help with the pain. She was in labor and awake on and off from Saturday morning until Monday night when she finally gave birth at Kaiser hospital in Riverside, California.
The patient is an 18 year old Spanish female who came to the unit on 11/31/2016 at 23:10 complaining of cramping and she had thought that her water had broken. Her pain was a 4 on a scale of 0-10 in her abdomen described as cramping. Upon examination she was dilated to 3cm, 80% effaced and the position of the baby was -2 and vertex. Her membranes remained intact. Her estimated due date was 10/28/2016. This is her first pregnancy. She has no history of abortion or miscarriage. She has had her flu vaccine and tdap vaccine in October, 2016. She has never smoked or done illegal drugs. She is negative for group b strep, hepatitis, HIV, and syphilis, gonorrhea, and chlamydia. She is rubella immune. There is a language barrier between the patient and the staff. The patient and her family only speak Spanish and only knew very little
Obstructed labour carries a high risk of maternal morbidity and mortality and is prevalent in the developing world. Common causes include congenital fetal abnormalities like polycystic kidneys, hydrocephalus, hydronephrosis, locked twins, uterine abnormalities, contracted pelvis & maternal pelvic tumours (1,2). A case of Prune belly Syndrome diagnosed in the postpartum period is presented here which led to obstructed labour. She was successfully managed by trans abdominal tapping of cystic masses and subsequently delivered vaginally.